A new population based study published in the Journal of Clinical Oncology and conducted by the National Cancer Institute on patients with newly diagnosed myeloma shows how initial myeloma treatment has moved from mostly traditional chemotherapy to novel therapies in less than 10 years. The percentage of patients receiving novel agents rose from approximately 4% in 1999 to 76% in 2007. During the same time frame, the use of conventional chemotherapy (melphalan, vincristine and doxorubicin) decreased significantly. In addition, researchers determined that the combination of novel agents, chemotherapy, and a transplant became more common over time (from 0.6 percent to 18 percent). The percent of hematopoetic stem cell transplants (HSCT) also doubled during this period from approximately 11% to 22%.
Additional trends uncovered were the variations in use of novel treatments and HSCT by race and type of insurance. For white patients, use of novel agents was lower for those with Medicare only (42.6%) than for those with private insurance (50.2%). For patients of other races, those with Medicare only or Medicaid were less likely to receive novel agents or transplantation compared with those with private insurance. The researchers postulate that the high out of pocket costs for Medicare patients on myeloma medications (around 20%) is a likely factor driving this trend.
While the rate of transplant went up, it is still considered quite low. The authors offer two potential explanations: Either providers were relying on older clinical data on the benefit of transplant over chemo, or the number of transplant eligible patients is increasing with the advent of more effective novel front-line agents.
The abstract can be viewed here: http://jco.ascopubs.org/content/early/2013/04/08/JCO.2012.46.3323.abstract
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